From the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.)
From the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.).
AJNR Am J Neuroradiol. 2018 Apr;39(4):756-761. doi: 10.3174/ajnr.A5554. Epub 2018 Feb 15.
Ultrasound is a standard technique to detect lymph node metastasis in papillary thyroid cancer. Cystic changes and microcalcifications are the most specific features of metastasis, but with low sensitivity. This prospective study compared the diagnostic accuracy of a predictive model for sonographic evaluation of lymph nodes relative to the radiologist's standard assessment in detecting papillary thyroid cancer metastasis in patients after thyroidectomy.
Cervical lymph node sonographic images were reported by a radiologist (R method) per standard practice. The same images were independently evaluated by another radiologist using a sonographic predictive model (M method). A test was considered positive for metastasis if the R or M method suggested lymph node biopsy. The result of lymph node biopsy or surgical pathology was used as the reference standard. We estimated relative true-positive fraction and relative false-positive fraction using log-linear models for correlated binary data for the M method compared with the R method.
A total of 237 lymph nodes in 103 patients were evaluated. Our analysis of relative true-positive fraction and relative false-positive fraction included 54 nodes with pathologic results in which at least 1 method (R or M) was positive. The M method had a higher relative true-positive fraction of 1.46 (95% CI, 1.12-1.91; = .006) and a lower relative false-positive fraction of 0.58 (95% CI, 0.36-0.92; = .02) compared with the R method.
The sonographic predictive model outperformed the standard assessment to detect lymph node metastasis in patients with papillary thyroid cancer and may reduce unnecessary biopsies.
超声是检测甲状腺乳头状癌淋巴结转移的标准技术。囊性变和微钙化是转移的最特异特征，但敏感性低。本前瞻性研究比较了超声预测模型评估甲状腺癌术后患者淋巴结对放射科医生标准评估的诊断准确性，以检测甲状腺乳头状癌转移。
由放射科医生（R 法）按标准操作报告颈部淋巴结超声图像。另一名放射科医生使用超声预测模型（M 法）对同一图像进行独立评估。如果 R 或 M 法提示淋巴结活检，则认为该试验为阳性。淋巴结活检或手术病理结果为参考标准。我们使用对数线性模型对相关二项数据进行分析，估计 M 法与 R 法相比的相对真阳性率和相对假阳性率。
共评估了 103 例患者的 237 个淋巴结。我们的相对真阳性率和相对假阳性率分析包括 54 个有病理结果的淋巴结，其中至少有 1 种方法（R 或 M）为阳性。与 R 法相比，M 法的相对真阳性率更高（1.46，95%CI，1.12-1.91； =.006），相对假阳性率更低（0.58，95%CI，0.36-0.92； =.02）。
超声预测模型优于标准评估，可检测甲状腺乳头状癌患者的淋巴结转移，并可能减少不必要的活检。
